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I started on Truvada and Efavirenz about 5 weeks ago. In the first week after I started the medication, I experienced the usual side effects of giddiness, bad moods and the feeling of being "stoned" in the mornings. It gradually got better over the next few weeks.

However, the side effects of feeling "stoned" and very bad moods/ anger seem to have come back, worse than when I first started. I find this puzzling as I thought that the side effects would gradually get better as the weeks progressed. I take my medication around 10pm, about 2 hours before bedtime. I also eat my dinner 2 to 3 hours before my medication.

I feel very distressed as this is affecting the quality of my life and my productivity at work. What can I do? Should I wait it out for another month to see if it gets better or should I talk to my doctor about changing my medication? I'm worried and would like to find a solution to this. Please help!

This is not an uncommon problem. Stocrin (aka Sustiva/efavirenz) side-effects can occur even months after starting. If it doesn't get better in the next week or so, you need to talk to your doctor about substituting another med for the Stocrin portion of your combo. You will need to talk to your doctor about what other meds are available in your country.

"...health will finally be seen not as a blessing to be wished for, but as a human right to be fought for." Kofi Annan

Nymphomaniac: a woman as obsessed with sex as an average man. Mignon McLaughlin

HIV is certainly character-building. It's made me see all of the shallow things we cling to, like ego and vanity. Of course, I'd rather have a few more T-cells and a little less character. Randy Shilts

I don't have a history of mental illness of anything close and don't understand why such feelings of anger, panic attacks can be so severe and intense. I know it's a side effect of efavirenz and I am hoping that i don't have to change meds. My doc has asked me to continue for another 4 weeks but I don't know how long I can take it anymore. But I will try.

You don't necessarily have to have a history of mental health issues in order to have these types of side-effects from Stocrin - it can happen to any one of us.

A month can feel like an awful long time when you're feeling miserable. Personally, I'd be inclined to only give it another week or two. The fact that these side-effects came back even stronger than they appeared in the beginning would worry me.

"...health will finally be seen not as a blessing to be wished for, but as a human right to be fought for." Kofi Annan

Nymphomaniac: a woman as obsessed with sex as an average man. Mignon McLaughlin

HIV is certainly character-building. It's made me see all of the shallow things we cling to, like ego and vanity. Of course, I'd rather have a few more T-cells and a little less character. Randy Shilts

i'm right there with ya singleman, my mood swings have been awful and angry all the time plus the sleep issues. my doctor said we can change it anytime i wanted, so this may be in the cards on my next 3 month visit.

For some people the effects go on and on. If they are unaceptable then there are plenty of alternatives. Set your time limit for the head effects to resolve, and if they don't speak to your doc about taking sommat different

"...health will finally be seen not as a blessing to be wished for, but as a human right to be fought for." Kofi Annan

Nymphomaniac: a woman as obsessed with sex as an average man. Mignon McLaughlin

HIV is certainly character-building. It's made me see all of the shallow things we cling to, like ego and vanity. Of course, I'd rather have a few more T-cells and a little less character. Randy Shilts

Rilpivirine (Endurant, another non-nucleoside reverse transcriptase inhibitor) was recently approved by the FDA only earlier this summer and is also a once-a-day pill. Rilpivirine was just rolled out into a new one-pill once-a-day treatment combined with Truvada under the name Complera. As far as I know, Complera is currently only approved for treatment naive individuals, but I'd imagine that will change in the next few years. The main difference is that Rilpivirine or the combined tablet, Complera, needs to be taken with a full meal, whereas Atripla (Truvada + Sustiva/Stocrin) should be taken on an empty stomach.

I *think* that at this point, Rilpivirine is only FDA-approved for those beginning HAART therapy for the first time. However, if you continue to have issues with the efavirenz, it might be worthwhile discussing the option of using rilpivirine with your doctor.

My doctor suggested two options - changing the efavirenz portion to Reyataz OR decrease the dose of efavirenz.

What are the pros and cons of each?

How safe is Reyataz? What are the side effects and how common? What's the price point compared to efavirenz?

Any advice is deeply appreciated.

My bf takes only 200mgs of efavirenz daily instead of the usual 600mgs. They first dropped him down to 400mgs.

However, they just didn't drop his doses and hope for the best at the next blood draw. They used something called Therapeutic Drug Monitoring (TDM) each time to make sure he was still getting enough efavirenz in his blood stream. Personally, I don't think I'd agree to dropping the dose of any hiv med unless they used TDM to make sure I was still getting an optimal amount of the drug into my system.

Reyataz is generally a good med with few side-effects. That's what I plan to use (with Truvada) when it's time for me to start meds. (I refuse to take efavirenz due to the possible CNS side effects).

"...health will finally be seen not as a blessing to be wished for, but as a human right to be fought for." Kofi Annan

Nymphomaniac: a woman as obsessed with sex as an average man. Mignon McLaughlin

HIV is certainly character-building. It's made me see all of the shallow things we cling to, like ego and vanity. Of course, I'd rather have a few more T-cells and a little less character. Randy Shilts

PS - cutting the efavirenz in half will make no difference, the drug reaches a steady state concentration after 5 days and how you top it up is neither here nor there. If you want to investigate a lower dose speak to your doc about TDM, as has already been said.

I thought there had been a bit of improvement in feeling stoned during day for weeks 1-5 and then had week 6 which was pretty bad, found it difficult to follow a conversation. I was thinking of asking for a different regimen. My dr told me to hang on a few more weeks, to him weeks 6-7 is a grey area in working out if the side effects are permanent.

Anyway the past 3 days I doubled the time with empty stomach from 2 to 4 hours before dosing, really inconvenient but it has massively reduced side effects, to the point where I am going to stay on for another 2 weeks and am starting to feel hopeful that this willl work out for me. Might be worth trying for you before you switch. However I understand that side effects are very real and debilitating so I am not suggest you just put up with them. I have just found something that hopefully might make things work out for me.

Hi, I guess that I have decided its 'good enough' for now. I think my concentration has improved but its definitely a bit dulll. I have a hungover feeling for the first hour when I get up. And I have a recurrent mild headache.

But I that's really it, and if I just got a little bit of an improvement in concentration I would consider my self OK. So its 8 weeks since I started on Monday and my doctor, who I saw today, thinks there is chance that I willl get a little bit more improvement so I have decided to hang in there. I had a really tough week at work (not due to meds) so I am thinking that might have aggravated things as well. I wish you well with your treatment and hope we still have a little improvement to come

I was saying last week I felt great, i was present, no mind fogginess, hangover, but it came back this week, though it is much milder than previously.

Part of me wants to continue the drug and hope to see improvement in the side effect and part of me wants to just change the drug because there is no guarantee it will get better and I need to be 100% at work